The changing face of RCM
Under self-pay structures, a significant amount of payments for medical costs is shifted from the commercial insurance company to the patient. This increases the need for hybrid performance in revenue cycle management solutions, said Brad Lund, executive director of the Healthcare Billing and Management Association. “If you send a clean claim to the insurance company, they send back a check, whereas the self-pay side is much more challenging,” he said. HBMA represents companies that manage revenue cycle operations for physician groups – a membership that accounts for 30 percent of all claims in the industry. Lund said the association is educating providers on properly managing claims ahead of major transitions, including RAC and ICD-10 – both of which, like self-pay, will have a great impact on RCM technology.
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 The onset of new programs like Medicare’s RAC and the ICD-10 coding system will keep revenue cycle managers busy. |
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3 TRENDS TO WATCH
Brad Lund, executive director of the Healthcare Billing and Management Association, sees these three trends affecting revenue cycle management:
1.RECOVERY AUDITS: Medicare’s RAC audits are affecting nearly every financial process for healthcare providers. As RAC auditors aim to find irregular claims information, providers need to ensure their systems can appropriately manage and process all financial data.
2.ICD-10: RCM and practice management systems that aren’t ready for ICD-10 will leave users facing significant billing issues, Lund said. Solutions that will accommodate the major transition from ICD-9 will rise to the top.
3.EMR PROJECTS: Providers implementing EMRs should be focused on integration with their RCM solution. “The whole EMR thing is on the clinical side. And that’s OK, but we can’t forget the financial relationship between the patient encounter and how you’re moving that information to the payer and how the adjudication is moving back to the provider,” said Lund. |
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VENDOR SHOWCASE
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Alpha II
CodingSystem
A comprehensive, front-end code search and editing software, CodingSystem provides faster, more accurate coding so medical coders can minimize denials, demonstrate medical necessity, ensure compliance and capture more legitimate reimbursement.
Contact: Alpha II CodingSystem Sales: 888.889.6777, info@alphaII.com
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Caremedic Systems
Electronic Financial Record (eFR)
The eFR’s sophisticated technology automates workflow, tracks account activity and identifies backlogs and black holes while enabling superior denial management. The solution unites data from disparate systems and provides a single point of access to patient-centric financial information. Using the eFR, providers are able to reduce denials, write-offs, A/R days and cost to collect while improving cash flow. The eFR’s integrated dashboard provides comprehensive, customizable reporting, drill-down to patient level data and powerful analytics.
Contact: Jose Miranda, 800.508.8494, products@caremedic.com
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Concuity
ClearContracts
Concuity ClearContracts is a Web-based revenue cycle management solution that allows healthcare organizations to manage the entire contract revenue cycle. It goes beyond legacy calculation engines, allowing one to create and negotiate profitable contracts, streamline contract interpretation, compliance and month-end processes as well as collect what’s rightfully owed from payer relationships.
Contact: http://www.concuity.com
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Craneware
ChargeMaster ToolKit
Craneware’s Chargemaster Toolkit is the original Charge Description Master solution, ranked No. 1 in the KLAS Revenue Cycle – Chargemaster Management category for the last three years. Designed to capture legitimate reimbursement by automating chargemaster management processes, it is customizable for organizations from small community hospitals to large healthcare networks.
Contact: Craneware, Inc., 5770 Hoffner Ave., Suite 102, Orlando, FL 32822; E-mail HYPERLINK “mailto:sales@craneware.com,” sales@craneware.com. Toll-free: 1.877.624.2792.
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Eclipsys
Sunrise Patient Financials
Sunrise Patient Financials is a comprehensive revenue cycle management solution that spans the entire revenue cycle process, including scheduling, registration, clinical care and billing processes. By integrating financial and clinical operations, this solution helps healthcare organizations reduce costs associated with unauthorized services and mismanaged resources and improve reimbursement.
Contact: Brad Tinnermon, 404.847.5224, Bradley.Tinnermon@Eclipsys.com
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Hyland Software
OnBase
Hyland Software develops OnBase, a suite of document and process management applications. By removing paper and uniting data throughout the revenue cycle – from registration to final payment – OnBase allows staff to focus on what brings cash in the door faster. More claims are accepted, reimbursements are maximized, cash flow is accelerated and receivable days are decreased when healthcare organizations – from small physician practices to large hospital systems – use OnBase to manage the revenue cycle.
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McKesson
Horizon Enterprise Revenue Management supports the reinvention of revenue management practices as a comprehensive financial solution. The solution redefines the processes, relationships and organizational structures associated with the three disciplines of financial management: consumer management (interactions between the healthcare organization and the patient), business management (the creation of charges, distribution of claims and receipt of payments), and access management (the collection of information that assists in treating patients, meeting regulatory requirements and collecting full payment for services).
Contact: www.mckesson.com.
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MedSynergies
RCM Technology Services
Leveraging the right process with the right people and technology, MedSynergies RCM services, including business process analysis and software integration, assist healthcare organizations with GE/IDX Groupcast billing environments by lowering denial rates, accelerating cash flows and increasing profits.
Contact: Clayton Harbeck, 888.275.9410, info@medsynergies.com.
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MPV
Patient Portion Pricer
MPV Patient Portion Pricer enables practices to accurately calculate insurance allowables at or before the time of service so they can determine the patient’s portion of the bill for medical procedures based on applicable deductibles, co-insurance and other patient responsibilities.
Contact: Merideth Wilson, merideth.wilson@mpv.com, 866.930.1230
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Navicure
Claims Management
Navicure is a leading Internet-based claims clearinghouse that helps physician practices increase profitability through improved claims reimbursement and staff productivity. The company’s solution is supported by its unique 3 Ring client service. Navicure was named “Best in KLAS” clearinghouse in KLAS’ 2008 Top 20 Best in KLAS Awards report.
Contact: Matthew Halkos, 877.280.3334, sales@navicure.com, www.navicure.com.
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NextGen Healthcare Information Systems
Practice Solutions
NextGen Practice Solutions is a technology-driven revenue-improvement services group that will help create an efficient and effective business operation so that one can focus on patients – and get paid faster, too. Services include A/R management, billing/collections, provider enrollment, technology solutions and more – all fully integrated with EHR, a patient portal and ePrescribing.
Contact: Joe Purnell, 404.467.1500, jpurnell@nextgen.com, http://www.nextgen.com/ps.
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PCG Software
Virtual Reporter
Virtual Reporter is a workflow management application that serves as the user interface for PCG’s fraud and abuse prevention software. It automatically updates claims on the host system to improve workflow efficiency and flexibility when detecting fraudulent, abusive and wasteful billing practices.
Contact: PCG Software, Virtual Reporter sales: 877.789.1291, info@pcgsoftware.com.
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Select Health Management
Charge Capture Integrity Program
The “Charge Capture Integrity Program” offers a well-proven technology to identify charges lost during the often complex and broken hospital charge capture process. The technology is applied on a retroactive population of one’s data (for example, the prior six months of recent activity) and/or on a real time basis. Management by exception reporting is written around seven key clinical modules with the ability to customize the application and its edits to meet a hospital’s specific service line needs. The technology is well proven and minimizes false positives. The program offers identification, validation, prevention and maintenance. This technology enables hospitals to stop losing out on revenue that they deserve and facilitates accurate charge capture processes. Validated results are immediate and quantifiable.
Contact: Jackie Francis, president, Select Health Management, Inc., jfrancis@shminc.org, http://www.shminc.org, 239.775.7773.
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ZirMed
ZirMed is a nationally recognized leader in delivering revenue cycle management solutions to healthcare providers, enabling them to leverage the power of technology to cure administrative burdens and increase cash flow. The company’s solutions include eligibility verification, credit/debit card processing, check processing, claims management, coding compliancy and reimbursement management, electronic remittance advice, patient statements, patient e-commerce solutions, provider credentialing and lock box services. ZirMed’s technology is designed to complement provider workflow and provide innovative, creative and flexible solutions for healthcare’s most pressing administrative challenges.
Contact: www.zirmed.com.
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Picis CareSuite
Picis CareSuite automates the clinical documentation and business practices in the ED, OR and ICU, providing a seamless flow of data across the continuum of care. Offering increased efficiency, improved communication, and integrated patient safety features, Picis solutions provide clinicians with the information they need at the point of care.
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User Reviews
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 "MPV streamlines revenue cycle management by giving us the ability to automate time-consuming manual processes, minimize errors and more accurately estimate a patient’s out-of-pocket expenses. Through our use of MPV Patient Portion Pricer, we’ve experienced a 12 percent increase in patient collections and a 13 percent decrease in bad debt."
Lisa S. Conner, CMPE, CASC, business office manager, Lake Charles Medical & Surgical Clinic. |
 "Craneware’s Chargemaster Toolkit identified a $3.6 million revenue opportunity from 55 radiology charges that were priced below the Medicare APC.”
Brian Patterson, Chargemaster coordinator, University Health Care System, Augusta, Ga. |
"Prior to implementing CareMedic’s eFR for denial management and reporting, denials for Renown Health were reported at 22 percent and averaged approximately $22 million a month. Since implementation in 2006, we have seen a dramatic decrease in our denials and are proud to report our denials at 3.5 percent with an average $5 million a month in denied charges. We attribute this decrease to CareMedic’s denial management and ease of reporting through the eFR. We are able to easily identify and track our denials using reliable and consistent methods."
Yvonne Clark, systemadministrator/patient financial services, Renown Health. |
“The ROI for Clear Contracts was realized in a very short time frame and we are very satisfied with the results. Our CFO had counted on an additional $1.5 million in recoveries and we have been able to deliver that and then some, making this the most successful project for the hospital this year.”
Paula Wilke, administrative director, Patient Financial Services, Edward Hospital & Health Services. |
““In the past, if someone needed documents for billing a collections appeal or insurance referral authorization, they had to request a paper chart located in a facility a couple of miles across campus. Because it’s paper – not to mention the geographical barrier – there was delay in receiving the documents. And what’s more, the departments incurred courier costs for the document delivery. There’s also the vulnerability of having only one copy of the paper. Our OnBase system provides redundancy for the information, eliminates the delays and costs of courier service, and possibly most importantly, provides security around our information. And while we can quantify these savings, it’s hard to measure the dollar value of better access to documents needed for billing and collections. But it certainly helps us increase revenue, makes us much more efficient and improves job satisfaction for admissions and patient financial services staff.”
Tim Leary, manager, Information Resources, University of Texas Southwestern Medical Center, Dallas, Texas. |
“The charge capture tool that we utilized (CAAT technology), gives us, as internal auditors, instant credibility with administration/finance and the clinical staff at our hospitals because the tool allows us to perform and identify potential lost charges on 100 percent of a population of patients rather than just doing a sample audit. A tool such as this allowed us to find opportunities in a much shorter amount of time that you would ever find just doing sample audits. The use of the technology has paid for itself many times over and it also minimized false positives.”
Renee Jaenicke, director of internal audit, Renown Health. |
“Prior to deploying the Picis Perioperative Dashboard (part of the Picis CareSuite® product family), we had a 45-50 percent first case on-time start range. With the new system, we’ve moved to the 80-85 percent range for first case on-time starts. This significant increase has saved our staff a great deal of time and headache, which has been a much-welcomed boost for employee morale”
Janet Burke, Lahey Clinic Medical Center |
